Ischaemic Heart Disease in New Zealand Maori and Non-Maori: An Age Adjusted Incidence in Hospitalised Patients Over 10 Years with Emphasis on Clinical Features in the Maori

Abstract: Ischaemic heart disease in New Zealand Maori and non-Maori: an age adjusted incidence in hospitalised patients over 10 years with emphasis on clinical features in the Maori. C. P. Dancaster and R. C. Tait, Aust. N.Z. J. Med., 1982, 12, pp. 267–270.
The average annual incidence in patients admitted to hospital with ischaemic heart disease is lower among Maori than non-Maori but Maori females under 55 years are particularly susceptible. The age adjusted incidence in this group is twice that of white females.
One-third of Maori patients had auricular fibrillation and large hearts and it is suggested that these patients have cardiomyopathy, probably alcohol induced, in addition to ischaemic heart disease. This group had the highest hospital mortality rate, 43%. The 30% hospital mortality rate among all Maori is three times that of non-Maori. Risk factors examined in the Maori included obesity (present in 65%), diabetes (in 30%), gout (in 23%) and hypertension (in 17%) of patients with ischaemic heart disease.     

Myasthenia gravis with thymoma is more common in the Maori and Pacific Island populations in New Zealand

Background: The association of myasthenia gravis (MG) with thymoma is well recognized. Our clinical impression has been that MG associated with thymoma may be more common in patients of Polynesian descent than in other races. Aim: To determine the influence of ethnicity on the association of MG with thymoma in our population. Method: Review of all cases of thymectomy performed at Greenlane Hospital in Auckland for the 20‐year period from June 1978 to June 1998. Results: There were 103 thymectomies performed in the study period. Fifty‐five thymomas were identified, 15 in subjects of Maori or Pacific Island ethnicity and 40 in subjects of other races, predominantly Caucasian. Ten of 15 Maori or Pacific Island subjects with thymoma had MG (67%), compared with 15 of 40 subjects of other races (37.5%, P = 0.05). The mean age of Maori or Pacific Island subjects with thymoma and MG was 42.5 years, compared with 56.3 years in subjects from other races (P = 0.06). All five Maori and Pacific Island subjects with invasive thymoma had MG, whereas only four of 15 subjects (27%) from other races with invasive tumours had MG (P < 0.01). The overall incidence of thymoma and the proportion of thymomas that were invasive did not differ between the ethnic groups. Conclusions: Myasthenia gravis with thymoma occurs more frequently among Maori or Pacific Island people than in other racial groups in our population. This is due to an increase in the proportion of cases with thymoma who have MG in this group, while the overall frequency of cases of thymoma is similar between groups. MG with thymoma in the Maori or Pacific Island populations also presents at a younger age and is more often associated with tumour invasion. (Intern Med J 2001; 31: 206–210)     

Fibromyalgia in Maori and European New Zealanders

Aim: The objectives of this study were to determine: (i) the prevalence of fibromyalgia (FM) in Maori and European New Zealanders; and (ii) whether an association exists between hypermobility and FM. Methods: The 1990 American College of Rheumatology classification criteria were used to determine the prevalence of FM (both criteria), widespread pain (WP) only, and a tender point score (TPS) ≥ 11 only, in subjects aged 12 years and older. Beighton's method was used to determine hypermobility. Results: The prevalence of FM in Maori (1.1%) and European (1.5%) New Zealanders was similar (an overall prevalence of 1.3%); 1.7% Maori and 3.9% Europeans had WP only; and 1.7% Maori and 0.9% Europeans had a TPS of ≥ 11 only. In Maori, the prevalence of WP and a TPS ≥ 11 were the same and similar to the prevalence of FM. In Europeans, WP was 2.6‐fold more common than FM. None of the subjects with FM, WP only or a TPS ≥ 11 only was hypermobile. Conclusion: The prevalence of FM was similar in Maori and European New Zealanders, and similar to most other population studies. In Maori, WP and a TPS ≥ 11 were equally specific for FM whereas in Europeans, WP was more sensitive but less specific for FM than a TPS ≥ 11. There was no association between hypermobility and FM.     

Kidney Disease after Heart and Lung Transplantation

Chronic kidney disease (CKD) is not only common after lung and heart transplantation but also is associated with increased morbidity and mortality due to multiple pre-, peri- and post-transplant factors. While the exact incidence of CKD in this population is not well-defined, it seems to have gradually increased over the years as older recipients are more frequently considered. The increasing success of the procedure and expanding transplant candidate pool has allowed many with comorbid conditions to receive a transplant, which was considered prohibitive in the past. This review presents risk factors that have been linked to CKD as well as interventions that may help alleviate this serious problem. The impact of pretransplant renal function and the overexaggerated role of chronic nephrotoxicity of calcineurin inhibitors is discussed in detail. Until the exact pathophysiology of kidney disease is better understood, there is a dire need to expand the research agenda beyond observational studies.     

HbA1c screening for undiagnosed diabetes in New Zealand

OBJECTIVES: To describe a screening programme to detect undiagnosed diabetes in high-risk ethnic groups in New Zealand and determine the specificity and sensitivity of HbA(1c) to detect fasting hyperglycaemia. RESEARCH DESIGN AND METHODS: HbA(1c) was offered to subjects over 20 years of age participating in a screening programme for hepatitis B that was targeted at non-European populations. Two hundred and forty-four predominantly Maori subjects, with HbA(1c) levels 5 to 7.9% and who were not known to have diabetes, were tested with an oral glucose tolerance test. Comparison was made with fasting and 2-h samples. RESULTS: Fifty thousand eight hundred and nineteen subjects were screened using HbA(1c). 12% had HbA(1c) levels of 6.1% or more, and in 4% of the population HbA(1c) was 7.1% or more. Maori, Pacific Island people, and Indians had particularly high rates of elevated HbA(1c). HbA(1c) levels of 6.1% and greater were 94% sensitive and 77% specific in detecting the 32 subjects who had a fasting glucose of 7.0 mmol/L or more, and 90% sensitive and 73% specific for 20 subjects with a 2-h glucose of 11.1 mmol/L or more. CONCLUSIONS: Rates of elevated HbA(1c) levels in non-Europeans in New Zealand are very high, particularly in Maori, Pacific Island Peoples', and Indians, reflecting their high risk of diabetes and vascular disease. HbA(1c) can be used as an opportunistic screening test for diabetes and glucose intolerance, but a high level should be followed by an oral glucose tolerance test.     

Functional Capacity Following Univentricular Repair—Midterm Outcome

Objective. Previous studies have seldom compared functional capacity in children following Fontan procedure alongside those with Glenn operation as destination therapy. We hypothesized that Fontan circulation enables better midterm submaximal exercise capacity as compared to Glenn physiology and evaluated this using the 6‐minute walk test. Design and Patients. Fifty‐seven children aged 5–18 years with Glenn (44) or Fontan (13) operations were evaluated with standard 6‐minute walk protocols. Results. Baseline SpO₂ was significantly lower in Glenn patients younger than 10 years compared to Fontan counterparts and similar in the two groups in older children. Postexercise SpO₂ fell significantly in Glenn patients compared to the Fontan group. There was no statistically significant difference in baseline, postexercise, or postrecovery heart rates (HRs), or 6‐minute walk distances in the two groups. Multiple regression analysis revealed lower resting HR, higher resting SpO₂, and younger age at latest operation to be significant determinants of longer 6‐minute walk distance. Multiple regression analysis also established that younger age at operation, higher resting SpO₂, Fontan operation, lower resting HR, and lower postexercise HR were significant determinants of higher postexercise SpO₂. Younger age at operation and exercise, lower resting HR and postexercise HR, higher resting SpO₂ and postexercise SpO₂, and dominant ventricular morphology being left ventricular or indeterminate/mixed had significant association with better 6‐minute work on multiple regression analysis. Lower resting HR had linear association with longer 6‐minute walk distances in the Glenn patients. Conclusions. Compared to Glenn physiology, Fontan operation did not have better submaximal exercise capacity assessed by walk distance or work on multiple regression analysis. Lower resting HR, higher resting SpO₂, and younger age at operation were factors uniformly associated with better submaximal exercise capacity.     

Lessons Learned from the Pediatric Heart Transplant Study

The Pediatric Heart Transplant Study (PHTS) group was founded in 1991 as a voluntary, collaborative effort dedicated to the advancement of the science and treatment of children following listing for heart transplantation. Since 1993, the PHTS has collected data in an international, prospective, event‐driven database that examines risk factors for outcome events following listing for transplantation. The events include transplantation, death, rejection, infection, malignancy, graft vasculopathy, and retransplantation. Over its 12 years of existence, the PHTS has made major contributions to the field of pediatric heart transplantation, especially in the areas of outcome analysis and risk factor assessment for death and other major morbidities after listing and after transplantation. The new challenges facing the PHTS include how to implement the practice of evidence‐based medicine in the field of pediatric heart transplantation and how to support ongoing data collection and analysis to provide long‐term outcomes as the PHTS subjects enter their second decade after transplantation.     

原位心脏移植后的病理改变

本文报告１例原拉心脏移植植术后存活２１４天。按１９９０年国际心脏移植学会统一的标准，给予七次心肌活检和尸检的急性排异划定级，结果显示本例有持续性的细胞排异反应和体液排异反应。且曾因抗排异药物的减量加快，而使排异加重。讨论了心肌活检对移植排异诊断的重要性，并讨论了死亡原因。     

Ethnic disparity of pancreatic cancer in New Zealand

Summary Background. The etiology of pancreatic cancer remains elusive. Identification of high-risk groups may enable targeted study to identify new markers and risk factors. Aim. To review the epidemiology of pancreatic cancer in New Zealand and identify any differences between ethnic groups. Methods. All cases notified with pancreatic cancer between 1988 and 1997 were identified from the New Zealand Cancer Registry. Age-specific and age-standardized incidence rates (ASR) of pancreatic cancer were calculated for the total sample and the ethnic subgroups (Maori, Pacific, and Other, which was predominantly European). Data on the site, morphology, stage of tumors, and survival times were also reviewed. Results. There were 3004 cases over the 10-yr period. Ethnic ASR comparisons demonstrated higher rates in Maori (7.3/100,000) compared with Pacific (6.4/100,000) and the Other (5.6/100,000) ethnic group. Males had higher incidence rates than females in Pacific and Other, but not in Maori because of the unusually high rate among Maori women (7.2/100,000). The most commonly identified site, morphological type, and stage at presentation were the head of the pancreas (80.9% of site-specified cases), adenocarcinoma (44.3% of histologically confirmed cases), and diffuse ± metastases (69.2% of staged cases), respectively. The median survival time was 92 d, and this did not differ significantly for the Maori and Other ethnic groups. Conclusion. The Maori have higher rates of pancreatic cancer than other ethnic groups in New Zealand, and do not show the expected male predominance. Maori women currently have one of the highest reported female rates in the world, and are a population that should be further investigated for disease markers and modifiable risk factors.     

Atrial Resynchronization Following Heart Transplantation in Childhood

Atrial Resynchronization After Transplant. Despite preserved left ventricular function, exercise capacity is often impaired after cardiac transplantation due to autonomic denervation of the donor's sinus node. We present our experience with atrio‐atrial resynchronization in 2 pediatric heart transplant recipients. Both were highly active, suffered from chronotropic incompetence, and underwent successful atrial resynchronization with an objective improvement in exercise capacity, restoration of a physiologic chronotropic response, and resolution of dyspnea. Long‐term stable recipient sinus node function may, therefore, be maintained in some cardiac transplant recipients with standard atrio‐atrial anastomes. Atrio‐atrial pacing may be feasible and effective years after transplantation. (J Cardiovasc Electrophysiol, Vol. 21, pp. 577‐580, May 2010)     

Neurodevelopmental Outcomes in Infants after Surgery for Congenital Heart Disease: A Comparison of Single-Ventricle vs. Two-Ventricle Physiology

Introduction. The neurodevelopmental outcome of children with repaired congenital heart defect has risen in importance with improved survival. This study compares neurodevelopmental outcomes of children who had CHD with single ventricle physiology with those who had CHD with two-ventricle physiology. Patients and Methods. Participants included 112 infants discharged from the NICU between February 1999 to August 2006. The 12 infants who had a known genetic defect were excluded. Of the 100 infants 26 had single ventricle physiology and 74 had CHD with two-ventricle physiology. The children were seen in a follow-up clinic and growth parameters and standardized instruments were used to evaluate development. The referral rate to early intervention services was also compared. Results. The number of functional ventricles did not significantly differentiate growth parameters at 6–8 months of age. Early cognitive outcomes were relatively unimpaired in both the groups (single ventricle vs. two ventricle physiology). Early motor outcomes were worse in (p < 0.05) CHD with single ventricle physiology. The rate of referral for early intervention services was high in both groups compared to the average rate of referral in the state, but there was not a significant difference between the CHD groups. Conclusion. Significant differences noted on motor outcomes at the 6–8 month visit were no longer apparent in later visits. Referral to early intervention services is high in both the groups. These findings are important to those caring for infants with CHD because many of these patients may need referral for early intervention.